Bitkine, Chad – For Ache Kodo, seeing a doctor once meant saving money for the journey.
Living in Bitkine, in central Chad, she said a medical visit could mean paying for transport, the consultation and other costs of travelling to a larger town.
Now, she can consult a doctor remotely through a Telemedan kiosk closer to home.
“Telemedan changed how my family accessed healthcare services,” Ache told Al Jazeera. “It was difficult before, as it involved me saving money to travel just to see a doctor. Now I’m able to do it on time with fewer costs from where I am. It has also enhanced my economic status.”
For people in rural Chad, distance can be as much of a barrier to healthcare as the shortage of doctors themselves. Medical facilities and specialists are concentrated in larger towns and cities, leaving many communities far from basic services.
Abakar Mahamat grew up with that reality.
“The problem wasn’t only the lack of doctors,” he said. “It was also the distance between those doctors and the communities that needed them.”
In ۲۰۲۱, he launched Telemedan, a telemedicine initiative designed to bring consultations closer to communities where electricity, internet access and medical infrastructure are limited.
“Instead of asking people to travel hundreds of kilometres to find a doctor, I wanted to use technology to bring the doctor closer to them,” Abakar told Al Jazeera.
A clinic powered by the sun
The kiosks run on solar panels and batteries, allowing them to operate without reliable grid electricity.
A local operator registers the patient and takes basic measurements using equipment including blood-pressure monitors, glucometers, thermometers, pulse oximeters and electrocardiogram (ECG) machines.
The doctor joins remotely, appearing on a screen as the operator assists with the examination.
Telemedan says its kiosks can also be equipped with diagnostic tools including stethoscopes, temperature sensors and, in some cases, ultrasound equipment. A trained local operator helps patients use them.
The system is designed for places where internet access may be unreliable. Patient information can be stored locally and synchronised when connectivity returns. An Unstructured Supplementary Service Data (USSD) service allows people without internet access to book appointments and access health information.
Depending on the location, the kiosks can connect through mobile networks or satellite links.
“We want to see that the absence of reliable electricity or the internet should not mean the absence of healthcare,” Abakar said.
The cost of getting to a doctor
Abakar said some journeys for medical care can cost $۲۰۰ or more once transport, accommodation, logistics and medical consultations are included.
Telemedan consultations cost between $۲ and $۱۵, depending on the service.
For Abakar, the issue is also about what families can afford to give up to obtain care.
“A patient should not have to choose between seeking medical care and being able to feed their family,” he said.
From pilot to wider network
Telemedan began as a pilot and has expanded with support from grants and institutional partnerships, including Chad’s Ministry of Public Health and Prevention.
Abakar said the initiative now has ۳۷ kiosks across ۱۱ provinces and has reached an estimated ۱۴۳,۰۰۰ people.
Telemedan has also begun using artificial intelligence to help screen for diabetic retinopathy, a complication of diabetes that can damage vision. The initiative says the technology is intended to assist healthcare professionals rather than replace them.
But a remote consultation has limits.
A kiosk cannot provide emergency treatment or perform every examination. Patients who need specialist care, laboratory tests, medicines or hospital treatment still have to reach the next level of the health system.
Can the kiosks last?
Telemedan’s expansion comes as Chad develops its wider digital health system.
Youssouf Silay, an assistant to the coordinator of Chad’s National Digital Health Programme, told Al Jazeera that the country’s National Health Development Plan for ۲۰۲۲–۲۰۳۰ identifies digital health as a way to expand access to care.
Chad established the National Telemedicine Programme in ۲۰۲۱ and launched its National Digital Health Programme in ۲۰۲۳, Youssouf said. The Ministry of Health is also developing a legal and regulatory framework for digital health services.
“The objective is to promote innovative solutions that can improve access to healthcare, particularly in areas with limited medical and energy infrastructure,” Youssouf told Al Jazeera. “Solutions such as solar-powered telemedicine kiosks can contribute to this effort by bringing healthcare services closer to underserved populations.”
But putting a kiosk in a village is only the beginning.
The equipment has to keep working. Connectivity has to be available. Local operators need training. Doctors need to be there when patients call. And people who need care beyond the kiosk need a way to reach it.
Each kiosk costs about $۱۰,۰۰۰, according to Abakar. Telemedan sells the units to governments, public health programmes and partner organisations, which then operate them. The model means patients are not paying for the infrastructure itself.
Telemedan says it wants to reach one million people in rural communities across sub-Saharan Africa.
A solar-powered kiosk cannot replace a hospital. It cannot replace a doctor in every circumstance.
But it can shorten the distance between a patient and the health system.
“We want Telemedan to become a sustainable layer of healthcare infrastructure, not simply a collection of technology projects,” Abakar told Al Jazeera.
